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Laparoscopic Better Than Open Approach for Donor Site Preparation: Presented at ACS
By Roberta Friedman, PhD
SAN FRANCISCO -- October 17, 2008 -- Laparotomy may be safer for preparing the donor site for breast reconstruction, according to findings of a retrospective study presented here at the American College of Surgeons (ACS) 94th Annual Clinical Congress.
Dunya Mary Atisha, MD, University of Michigan, Ann Arbor, Michigan, conducted the retrospective study of breast cancer patients treated from 2001 to 2008 at either the University of Michigan or the Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
Patients who had open surgery to prepare the flap had a higher rate of hernias (P = .038), Dr. Atisha said.
"Laparotomy delay is a viable option for flap delay and may decrease donor site morbidity," she said.
All patients had delayed pedicle transverse rectus abdominis muscle (TRAM) breast reconstruction, with inferior epigastric vessels ligated bilaterally; 39 women underwent had TRAM by the open approach (by suprapubic skin incision) to prepare the flap and 104 women had laparotomy.
Delay time was 12 days for laparotomy and 41 days for open surgery. Open surgery resulted in significantly higher incidence of site complications (odds ratio, 1.49, P = .06).
Both centres use the delayed procedures routinely due to an increased rate of ischaemic events without the delay, said Dr. Atisha. "We try to coordinate with sentinel node biopsy or laparoscopic oophorectomy."
The open or laparotomy delay procedures did not differ with respect to flap loss, added Dr. Atisha.
[Presentation title: Comparing the Outcomes of the Laparoscopic Versus Open Preliminary Delay Techniques for Pedicle TRAM Breast Reconstruction. Abstract S65]
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